CERRITOS COLLEGE

OCCUPATIONAL WORK EXPERIENCE EDUCATION 

STUDENT MUST ENROLL IN AT LEAST 7 UNITS OF COLLEGE CREDIT CLASSES, INCLUDING OCCUPATIONAL WORK EXPERIENCE.
STATEMENT OF COOPERATION - ROUGH DRAFT GET THIS APPROVED BY WORK EXPERIENCE INSTRUCTOR BEFORE WRITING ON PINK FORM Cerritos College does not unlawfully discriminate in educational opportunities on the basis of race, religion, sexual orientation, color, national origin, age, or marital status and is subject to Title VII of the Civil Rights Act of 1964 as amended.

                      

 

______________  ______  ________________

SEMESTER                              YEAR             STUDENT NUMBER

 

1. STUDENT _________________________________________________________________

                                      FIRST NAME                LAST                                                 ADDRESS                        CITY                              ZIP CODE           PHONE  

 

2. EMPLOYER _______________________________________________________________

                                     NAME                                                                              ADDRESS                         CITY                            ZIP CODE           PHONE  

3. STUDENT’S JOB STATUS        

 

A.      JOB TITLE _________________________________________________________

 

B.      MAIN DUTIES _______________________________________________________

 

4. Student is required to pursue a planned program of Work Experience which includes new or expanded responsibilities or learning opportunities beyond those experienced during present or previous employment.

 

5. List Vocational Education Major or Occupational Goal. ______________________________

 

6. STUDENT’S OBJECTIVES FOR THE PROGRAM:

 

            (1)_____________________________________________________________________

 

                _____________________________________________________________________

 

            (2) ____________________________________________________________________

 

                  ____________________________________________________________________

 

            (3) ____________________________________________________________________

 

                _____________________________________________________________________

 

EMPLOYER/CERRITOS COLLEGE APPROVAL:

                EMPLOYER:

            (PRINT)        ________________________________           CERRITOS COLLEGE

                                                                              (EMPLOYER OR REPRESENTATIVE NAME)

 

            (SIGNATURE) X by____________________________          X_by___________________

                                    (EMPLOYER OR REPRESENTATIVE)                                                                 (INSTRUCTOR/COORDINATOR)

 

Employer does not unlawfully discriminate on the basis of race, religion, color, national origin, age, or marital status.

 

STUDENT AGREEMENT:

I understand that I must complete the objectives stated above and maintain         signed X by____________________

enrollment in at least seven units of college credit classes including                                            (STUDENT)

Occupational Work Experience.